To close the 20-year mortality gap, we need to stop treating physical and mental health separately and focus on prevention, early support, and joined-up care that helps people stay well for longer.

People living with a severe mental illness are dying far too young, around 15-20 years earlier than average, due to physical health problems. This is not inevitable. Many of the physical health conditions that contribute to early deaths can be prevented, identified earlier, or managed better with the right support.

Here are changes we are calling for to improve the lives of people living with severe mental illness.

Recommendations for local practice

1. Get checked out

Regular physical health checks are vital for people living with severe mental illness, but follow-up support is what truly makes a difference. Peer support workers and health navigators can help boost check completion rates and connect people to ongoing care.

Recommendations:

• Expand peer support roles for physical health engagement.
• Increase regular reviews of smoking status and support, not just relying on annual checks.
  
  

2. Smoke-free future

Reducing smoking is key to closing the mortality gap for people living with severe mental illness. A whole-system approach, including accessible stop smoking support and specialist training, helps tackle stigma and encourages quitting.

Recommendations:

• Embed smoking cessation support in mental health services and ensure it reaches everyone who needs it.
• Mandate specialist training for professionals.
• Offer financial incentives like vouchers for quit attempts.
• Enforce smoke-free policies across all settings.
  
  

3. Getting moving

Physical activity, especially in peer-led groups, improves wellbeing and builds social connections for people living with severe mental illness. Support for carers and evidence-based training ensures everyone can access safe, enjoyable activities.

Recommendations:

• Embed physical activity advice and signposting in primary care.
• Use evidence-based training tools in activity projects.
• Scale up peer support.
  
  

4. Weight matters

Early, proactive support for weight management is essential, especially when starting antipsychotic treatment. Person-centred, flexible services focused on motivation and peer support help people make sustainable lifestyle changes.

Recommendations:

• Strengthen antipsychotic prescribing protocols and follow-up.
• Ensure equitable access to mental health-informed nutrition and weight-management support.
  
  

5. Investing in inpatient health

Physical health often declines during psychiatric hospital stays, so early support and healthy environments are crucial. Trained staff and peer champions inspire change, while holistic smoking cessation strategies address unique barriers.

Recommendations:

• Introduce healthy food standards and safe activity in wards.
• Start support for weight management and smoking cessation from admission.
  
  

6. Systems that care

Place-based mental health work brings together local services for joined-up, accessible care. Peer support workers, care navigators, and co-production with people with lived experience ensure services meet real needs.

Recommendations:

• Use peer support workers and care navigators to connect people to services.
• Co-produce services with people with lived experience for flexible, personalised support.
  
  

Policy recommendations for government

1. Cross-government plan

Improving physical health for people with severe mental illness needs real policy reform, sustained investment, and a joined-up government approach. The upcoming strategy must tackle both mental health support and the root causes of poor health.

2. Preventative investment

Prevention must be the focus of health spending, with preventative interventions co-designed with people who have lived experience of mental illness and delivered by mental health professionals and peer supporters. Research is needed to find what works best, and those most at risk should be prioritised.

3. Co-production

All services for people with SMI must be co-produced with those who have lived experience, including staff trained to understand the relationship between mental and physical health, and use local collaboration to tackle accessibility and inequality.

4. Workforce

A long-term strategy is needed to recruit, train and retain mental health professionals, ensuring they are better equipped to support both physical and mental health needs. Training routes, working conditions, pay, and peer support roles must be improved.

5. Data analysis

Better data collection is essential to track outcomes and guide future decisions. Evidence must shape future decision-making and commissioning.

6. Empower

Government must support and empower local and grassroots organisations, making funding and commissioning more accessible and embedding peer support and lived experience in service design.